A pilot study assessing the burden of caregivers of elderly patients at University College Hospital UCH.

12 Background: Caregiver burden is defined as “the perception of stress and fatigue caused by the sustained effort required in caring for persons with chronic illness or other conditions with special needs for care”. It is a type of stress or strain experienced by caregivers, which is directly/ indirectly related to the challenges/problems they face as a result of the health status of the person cared for. Stucki et al. 2000, described the carers burden as “strain or load borne by a person who cares for a chronically ill, disabled, or elderly family member”. Caregiver burden is response to physical, psychological, emotional, social, and financial stressors associated with the caregiving in a multidimensional way. It is the psychosocial and physical reaction to the imbalance of demands placed on the caregiver by various factors, including personal time, multiple roles, physical and emotional states, financial resources, and formal care resources. The caregiver's perception of the burden, rather than the perception of other family members or healthcare providers, determines the impact of this burden on his or her life. Methods: Caregivers of elderly patients attending the geriatric and medical outpatient’s clinics at UCH completed a caregiver strain index scale, over a 2 month period. Demographic information regarding gender, age, were obtained and scaled questions were ticked. Data was analysed using IBM SPSS statistics 21. Results: Eighty-five participants completed the caregiver strain index scale. The socio-demographic data described age and gender. Most participants fell in the 31 - 40 and 41 - 50 age groups (41.2% for each group). Fifty-eight (68.2%) were females while 27 (31.8%) were males. Most common strain variable was demand on time with percentage 54.1% (46). Twenty-nine (34.1%) had moderate level of stress (4 - 6) , while 32 (37.6%) had mild level of stress, and 17 (20.0%) had high level of stress. One participant had the highest score index was 11 while 13 (15.3%) had scores of 3 and 13 (15.3%) had scores of 5. Conclusions: The study showed that caregivers of elderly patients have high burden in the demand on their time and need supportive/collaborative systems which includes palliative care to help with the task of caring for these elderly ones.

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Caregiver burden in haemophilia: results from a single UK centre

The Journal of Haemophilia Practice ◽

10.17225/jhp00094 ◽

2017 ◽

Vol 4 (1) ◽

pp. 40-48 ◽

Cited By ~ 4

Author(s):

Kate Khair ◽

Sylvia Von Mackensen

Keyword(s):

Economic Impact ◽

Caregiver Burden ◽

Negative Impact ◽

Short Form ◽

Demographic Data ◽

Bodily Pain ◽

Perceived Burden ◽

Sf 36 ◽

Emotional Role ◽

The Impact

Abstract Haemophilia caregivers face limitations in their life leading to perceived burden. This single-centre study investigates the impact of burden on caregivers’ health-related quality of life (HRQoL). Methods: Questionnaires for caregivers comprised demographic data, HRQoL (EQ-5D, SF-36) and caregiver burden (IOF: Impact on Family Scale). Children were also asked about their HRQoL (EQ-5D, Haemo-QoL Short Form). Results: 20 consecutive parent/child dyads participated. 80% were mothers (mean age of 39.80±6.2 years) with 1-3 haemophilic children aged 8-17 years and 2.5±1.2 children <18 years living in the household. Mothers did most childcare (80%), 50% worked part-time, and 55% reported that haemophilia had an economic impact on their family. 80% of boys had haemophilia A; 60% were severely affected. Most received home treatment (85%) and prophylaxis (80%). Caregivers’ and boys’ HRQoL was similarly good (EQ-5Dparents M=0.90±0.1 vs. EQ-5Dchild M=0.81±0.3); by contrast, boys reported better values in the EQ-VAS (Mchild=90.25±10.0 vs. Mparents=82.16±14.8). Caregivers reported highest impairments in the dimensions ‘vitality’ (M=60.00±20.5) and ‘emotional role’ (M=70.37±42.6) of the SF-36. In the IOF, caregivers reported highest impairments in the dimension ‘negative impact’ (M=60.08±20.7). Caregivers reporting high burden had significantly worse HRQoL in the domains ‘bodily pain’ (p<.028) and ‘social functioning’ (p<0.024) of the SF-36. Caregivers who reported that haemophilia had an economic impact on their family and those with a chronic disease showed significant higher impairments in caregiver burden and their HRQoL. Conclusions: The perceived burden of haemophilia has a direct impact on caregivers’ HRQoL. Further studies with haemophilia-specific instruments are needed to verify these findings.

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How safe are elective craniotomies in elderly patients in neurosurgery today? A prospective cohort study of 1452 consecutive cases

Journal of Neurosurgery ◽

10.3171/2020.2.jns193460 ◽

2020 ◽

pp. 1-9

Author(s):

Ralph T. Schär ◽

Shpend Tashi ◽

Mattia Branca ◽

Nicole Söll ◽

Debora Cipriani ◽

...

Keyword(s):

Cohort Study ◽

Blood Loss ◽

Elderly Patients ◽

Age Groups ◽

Head Ct ◽

Estimated Blood Loss ◽

Group 3 ◽

Group 2 ◽

The Impact ◽

Group 1

OBJECTIVEWith global aging, elective craniotomies are increasingly being performed in elderly patients. There is a paucity of prospective studies evaluating the impact of these procedures on the geriatric population. The goal of this study was to assess the safety of elective craniotomies for elderly patients in modern neurosurgery.METHODSFor this cohort study, adult patients, who underwent elective craniotomies between November 1, 2011, and October 31, 2018, were allocated to 3 age groups (group 1, < 65 years [n = 1008], group 2, ≥ 65 to < 75 [n = 315], and group 3, ≥ 75 [n = 129]). Primary outcome was the 30-day mortality after craniotomy. Secondary outcomes included rate of delayed extubation (> 1 hour), need for emergency head CT scan and reoperation within 48 hours after surgery, length of postoperative intensive or intermediate care unit stay, hospital length of stay (LOS), and rate of discharge to home. Adjustment for American Society of Anesthesiologists Physical Status (ASA PS) class, estimated blood loss, and duration of surgery were analyzed as a comparison using multiple logistic regression. For significant differences a post hoc analysis was performed.RESULTSIn total, 1452 patients (mean age 55.4 ± 14.7 years) were included. The overall mortality rate was 0.55% (n = 8), with no significant differences between groups (group 1: 0.5% [95% binominal CI 0.2%, 1.2%]; group 2: 0.3% [95% binominal CI 0.0%, 1.7%]; group 3: 1.6% [95% binominal CI 0.2%, 5.5%]). Deceased patients had a significantly higher ASA PS class (2.88 ± 0.35 vs 2.42 ± 0.62; difference 0.46 [95% CI 0.03, 0.89]; p = 0.036) and increased estimated blood loss (1444 ± 1973 ml vs 436 ± 545 ml [95% CI 618, 1398]; p <0.001). Significant differences were found in the rate of postoperative head CT scans (group 1: 6.65% [n = 67], group 2: 7.30% [n = 23], group 3: 15.50% [n = 20]; p = 0.006), LOS (group 1: median 5 days [IQR 4; 7 days], group 2: 5 days [IQR 4; 7 days], and group 3: 7 days [5; 9 days]; p = 0.001), and rate of discharge to home (group 1: 79.0% [n = 796], group 2: 72.0% [n = 227], and group 3: 44.2% [n = 57]; p < 0.001).CONCLUSIONSMortality following elective craniotomy was low in all age groups. Today, elective craniotomy for well-selected patients is safe, and for elderly patients, too. Elderly patients are more dependent on discharge to other hospitals and postacute care facilities after elective craniotomy.Clinical trial registration no.: NCT01987648 (clinicaltrials.gov).

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Multidisciplinary Treatment for Colorectal Liver Metastases in Elderly Patients

10.21203/rs.3.rs-16362/v2 ◽

2020 ◽

Author(s):

Taigo Hata ◽

Yoshihiro Mise ◽

Yoshihiro Ono ◽

Takafumi Sato ◽

Yosuke Inoue ◽

...

Keyword(s):

Elderly Patients ◽

Liver Metastases ◽

Colorectal Liver Metastases ◽

Multidisciplinary Treatment ◽

Age Groups ◽

Age Group ◽

Liver Recurrence ◽

Initial Hepatectomy ◽

The Impact ◽

Disease Specific

Abstract Background: Limited data describe the therapeutic practice and outcomes of colorectal liver metastases (CRLMs) in elderly patients. We aimed to evaluate the impact of age on multidisciplinary treatment for CRLMs. Methods: We reviewed treatment and outcomes for patients in different age groups who underwent initial hepatectomy for CRLMs from 2004 through 2012.Results: We studied 462 patients who were divided into three groups by age: ≤ 64 years (n = 265), 65–74 years (n = 151), and ≥ 75 years (n = 46). The rate of major hepatectomy and incidence of postoperative complications did not differ between groups. Adjuvant chemotherapy was used less in the ≥ 75 -year group (19.6%) than that in the ≤ 64 (54.3%) or 65–74 age group (43.5%). Repeat hepatectomy for liver recurrence was performed less in the ≥ 75 -year group (35%) than in the ≤ 64 (57%) or 65–74 (66%) age group. The 5-year disease-specific survival (DSS) rate of 44.2% in the ≥ 75 -year group was lower than in the ≤ 64 (59.0%) or 65–74 (64.7%) age group. Multivariate analysis revealed age ≥ 75 years was an independent predictor of poor DSS.Conclusions: Liver resection for CRLMs can be performed safely in elderly patients. However, repeat resection for recurrence are performed less frequently in the elderly, which may lead to the poorer disease-specific prognosis.

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Efficacy of palliative chemotherapy in elderly patients with colorectal cancer

Zeitschrift für Gastroenterologie ◽

10.1055/a-0851-6978 ◽

2019 ◽

Vol 57 (04) ◽

pp. 484-490

Author(s):

Wolfram Bohle ◽

Amelie Pachlhofer ◽

Wolfram Zoller

Keyword(s):

Colorectal Cancer ◽

Multivariate Analysis ◽

Elderly Patients ◽

Metastatic Colorectal Cancer ◽

Primary Tumor ◽

Palliative Chemotherapy ◽

Age Groups ◽

Chemotherapeutic Agents ◽

Old Patients ◽

The Impact

Abstract Background The number of old patients suffering from colorectal cancer rises. In clinical trials, old patients are underrepresented, and chemotherapy is significantly less often performed in elderly patients. We analyzed the impact of elder age for palliative chemotherapy in patients suffering from metastatic colorectal cancer, according to therapeutic drugs used, intensity of treatment performed, and therapeutic results. Materials and methods We analyzed consecutive patients with metastatic colorectal cancer treated in palliative intention in our department. Assessed data included age (</> 75 years), sex, comorbidity, site of primary tumor, k-ras-status, site and amount of metastasis, number and kind of chemotherapeutic agents used, number of consecutive therapy lines performed, dose intensity, toxicity, time between start and end of palliative chemotherapy, and overall survival. Prognostic variables were tested in uni- and multivariate analysis. Results Ninety-seven patients (69 < 75, 18 > 75 years) were included. Age groups were well balanced according to site of primary tumor, k-ras-mutational status, localization, and number of metastatic sites. Cardial and renal comorbidity was more frequent in elderly patients. The median number of chemotherapeutic drugs used and lines of therapy performed did not differ between age groups, except of oxaliplatin, which was significantly less often used in old patients. Median survival did not differ between age groups (23.4 vs. 23.5 months). In multivariate analysis, only left-sided primary tumor and more than 3 lines of therapy performed were prognostic positive variables. Conclusion Old patients can profit from palliative chemotherapy to the same extent as younger ones.

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Outcomes and Risks With Age in Spondylolisthesis: A Comparison of the Elderly From the Quality Outcomes Database

Neurosurgery ◽

10.1093/neuros/nyz310_621 ◽

2019 ◽

Vol 66 (Supplement_1) ◽

Author(s):

Michael Karsy ◽

Andrew Kai-Hong Chan ◽

Michael S Virk ◽

Praveen V Mummaneni ◽

Mohamad Bydon ◽

...

Keyword(s):

Surgical Treatment ◽

Elderly Patients ◽

Rating Scale ◽

Age Groups ◽

The Elderly ◽

Quality Outcomes ◽

Degenerative Lumbar Spondylolisthesis ◽

Patient Reported ◽

Lumbar Spondylolisthesis ◽

The Impact

Abstract INTRODUCTION Degenerative lumbar spondylolisthesis affects 3% to 20% of the population with an increasing incidence of up to 30% in the elderly. The impact of age on surgical complication and patient reported outcomes (PRO) have yet to be evaluated in a modern, multicenter study. METHODS The Quality Outcomes Database (QOD) multicenter, prospective registry was used to evaluate patients from 12 US centers, including academic and private institutions, between July 2014 and June 2016 who underwent surgical treatment for grade 1 lumbar spondylolisthesis. All patients received at least 12 mo of follow-up RESULTS A total of 608 patients were divided into < 60 (n = 239), 60 to 70 (n = 209), 71 to 80 (n = 128), and > 80 (n = 32) categories. Older patients showed lower body mass index (BMI) (P = .00001), increased diabetes (P = .007), coronary artery disease (P = .0001), and osteoporosis (P = .005). A lower likelihood for home disposition was seen with the elderly (89.1% in < 60 yr olds vs 75% in > 80 yr olds), with more elderly patients discharged to skilled nursing facilities or rehabilitation (P = .002). No baseline differences in PROs (Oswestry Disability Index [ODI], EQ-5D [EuroQol healthy survey], Numeric Rating Scale for leg pain [NRS-LP] and back pain [NRS-BP]) were seen among age categories. A significant improvement for all QOLs was seen regardless of age (P < .05). Minimal clinically important differences (MCID) in QOLs were seen after surgery for all age groups. No differences in hospital readmissions (30-d, 3-mo) or reoperations (30-d, 1-yr, 2-yr, and 3-yr) were seen among age groups (P < .05). CONCLUSION Despite increased presurgical comorbidities and risk, well-selected elderly patients undergoing surgical treatment of grade 1 spondylolisthesis can achieve meaningful outcomes without increases in complications or readmission. However, PRO do not improve to the same degree in the elderly as in younger adults. This modern, multicenter US study reflects the current use and limitation of spondylolisthesis treatment in the elderly, which may be informative to patients and providers.

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Degenerative Cervical Myelopathy in Higher-Aged Patients: How Do They Benefit from Surgery?

Journal of Clinical Medicine ◽

10.3390/jcm9010062 ◽

2019 ◽

Vol 9 (1) ◽

pp. 62 ◽

Cited By ~ 1

Author(s):

Oliver Gembruch ◽

Ramazan Jabbarli ◽

Ali Rashidi ◽

Mehdi Chihi ◽

Nicolai El Hindy ◽

...

Keyword(s):

Elderly Patients ◽

Cervical Myelopathy ◽

Age Groups ◽

Age Group ◽

Group Effect ◽

Significant Group Effect ◽

Aged Patients ◽

Significant Group ◽

Degenerative Cervical Myelopathy ◽

The Impact

Background: Degenerative cervical myelopathy (DCM) is the most common reason for spinal cord disease in elderly patients. This study analyzes the preoperative status and postoperative outcome of higher-aged patients in comparison to young and elderly patients in order to determine the benefit to those patients from DCM surgery. Methods: A retrospective analysis of the clinical data, radiological findings, and operative reports of 411 patients treated surgically between 2007 and 2016 suffering from DCM was performed. The preoperative and postoperative neurological functions were evaluated using the modified Japanese Orthopedic Association Score (mJOA Score), the postoperative mJOA Score improvement, the neurological recovery rate (NRR) of the mJOA Score, and the minimum clinically important difference (MCID). The Charlson Comorbidity Index (CCI) was used to evaluate the impact of comorbidities on the preoperative and postoperative mJOA Score. The comparisons were performed between the following age groups: G1: ≤50 years, G2: 51–70 years, and G3: >70 years. Results: The preoperative and postoperative mJOA Score was significantly lower in G3 than in G2 and G1 (p < 0.0001). However, the mean mJOA Score’s improvement did not differ significantly (p = 0.81) between those groups six months after surgery (G1: 1.99 ± 1.04, G2: 2.01 ± 1.04, G: 2.00 ± 0.91). Furthermore, the MCID showed a significant improvement in every age-group. The CCI was evaluated for each age-group, showing a statistically significant group effect (p < 0.0001). Analysis of variance revealed a significant group effect on the delay (weeks) between symptom onset and surgery (p = 0.003). The duration of the stay at the hospital did differ significantly between the age groups (p < 0.0001). Conclusion: Preoperative and postoperative mJOA Scores, but not the extent of postoperative improvement, are affected by the patients’ age. Therefore, patients should be considered for DCM surgery regardless of their age.

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A hospital based study on the surgical outcomes of thyroid malignancies

International Surgery Journal ◽

10.18203/2349-2902.isj20185040 ◽

2018 ◽

Vol 5 (12) ◽

pp. 4035

Author(s):

R. Anuj Srinivasan ◽

K. Rajachidambaram ◽

Karthick P. ◽

M. Vijay Anand

Keyword(s):

Age Groups ◽

The Elderly ◽

College Hospital ◽

Thyroid Cancers ◽

Medical College ◽

Regional Metastasis ◽

Ultrasound Findings ◽

Thyroid Malignancies ◽

The Impact ◽

Insight Into

Background: Thyroid cancer is a heterogeneous disease that affects all age groups. The tumors are found to be more aggressive in the elderly. The distribution of these cancers in India continues to remain uncertain. The impact of geographic locations in the incidence of thyroid malignancies is yet to be explored. This study was done to estimate the prevalence and distribution of thyroid cancers.Methods: This hospital based retrospective study was done at the Department of Surgery of our medical college hospital. About 50 medical records of patients diagnosed with thyroid cancers at our hospital were analyzed. Data on clinical examination, ultrasound findings and histopathology findings were documented.Results: Out of the 50 patients studied 16 patients had dysphagia, eight patients had dyspnoea and 24 patients had regional metastasis. The most common surgery done for the primary cancer is total thyroidectomy. Hemithyroidectomy was done in 10 patients with SNG, out of which one patient had discrete lymph node per operatively and node dissection was carried out.Conclusions: TSH suppressive doses are recommended for all patients with papillary and follicular thyroid cancers. A cohort study to analyze the survival outcomes of the patients treated with both the surgical modalities will give an insight into the management of thyroid malignancies.

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Tinnitus and Otosclerosis: An Exploratory Study about the Prevalence, Features and Impact in Daily Life

International Archives of Otorhinolaryngology ◽

10.1055/s-0041-1739967 ◽

2021 ◽

Author(s):

Antonio Fontes Lima ◽

Filipa Carvalho Moreira ◽

Isabel Esteves Costa ◽

Catia Azevedo ◽

Fernando Mar ◽

...

Keyword(s):

Daily Life ◽

Demographic Data ◽

Age Groups ◽

Female Gender ◽

Tertiary Hospital ◽

Aged Patients ◽

Low Frequencies ◽

Female Predominance ◽

The Mean ◽

The Impact

Abstract Introduction Tinnitus is experienced by a significant part of the patients suffering from otosclerosis. Objective To assess the prevalence of tinnitus in otosclerosis, its main features, and the impact on the daily life. Methods Patients diagnosed with otosclerosis in 2019 in a tertiary hospital were enrolled in the study. Demographic data were retrieved and, besides a regular audiometric evaluation, the patients underwent acuphenometry to assess the psychoacoustic measurements (pitch and loudness), and the Tinnitus Handicap Inventory (THI). Results In total, 66 patients fulfilled the inclusion criteria, with a female predominance (63.6%; n = 42), and a mean age of 48.7 years. The mean air-bone gap was of 26.3 dB. A total of 72.7% complained of tinnitus; it was mostly unilateral, identified in the low frequencies, namely 500 Hz, with median loudness of 7.5 dB. The median score on the THI score was of 37; most patients had a mild handicap (33.3%, n = 16), followed by those with a severe handicap (22.9%; n = 11). The female gender had a statistically significant association with the presence of tinnitus. The THI scores were higher in middle-aged patients (age groups: 40 to 49 and 50 to 59 years), which was statistically significant. No correlation was found between audiometry results and the prevalence of tinnitus or score on the THI. On the other hand, high-pitched tinnitus, compared to low pitched-tinnitus, was associated with larger air-bone gaps. Conclusion The prevalence of tinnitus in our population was in line with the prevalences reported in the literature. It caused a catastrophic handicap in 22.9% of the patients. High-pitched tinnitus was associated with higher handicap. Nonetheless, the existence of tinnitus and its severity were not associated with the degree of hearing loss.

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The Impact of Type 2 Diabetes Mellitus on Long-Term Prognosis in Patients of Different Ages with Myocardial Infarction

Journal of Diabetes Research ◽

10.1155/2018/1780683 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 4

Author(s):

S. A. Afanasiev ◽

A. A. Garganeeva ◽

E. A. Kuzheleva ◽

A. V. Andriyanova ◽

D. S. Kondratieva ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Elderly Patients ◽

Age Groups ◽

Age Group ◽

Term Outcome ◽

Long Term Outcome ◽

The Impact

The objective of the study was to assess the impact of DM2 at baseline on long-term mortality after acute myocardial infarction (MI) among different age groups. The data were taken from: “Register of Acute Myocardial Infarction.” A total of 862 patients were followed for five years after acute myocardial infarction. The primary endpoint was death from any cause. The patients were categorized into 2 groups based on their ages: group 1—comprised patients older than working age (n=358) and group 2—comprised employable patients (n=504). A total of 208 patients were diagnosed with both cardiovascular disease and DM2. Elderly patients with DM2 had worse prognosis and increased five-year mortality compared with patients of the same age group without DM2. Statistically significant differences in long-term outcomes were found in adult patients (p=0.004) only in group with longer duration of diabetes, unlike the group with DM2 onset. In conclusion, Type 2 DM increased 5-year mortality rate of elderly patients with myocardial infarction. However, younger patients with both myocardial infarction and DM2 had more complications in the early post-MI period compared with patients of the same age group without DM2 but did not show any statistically significant differences in the long-term outcome.

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Including household effects in Big Data research: the experience of building a longitudinal residence algorithm using linked administrative data in Wales

International Journal for Population Data Science ◽

10.23889/ijpds.v3i1.452 ◽

2018 ◽

Vol 3 (1) ◽

Author(s):

Karen Susan Tingay ◽

Matthew Roberts ◽

Charles B.A. Musselwhite

Keyword(s):

Large Scale ◽

Emotional Health ◽

Demographic Data ◽

Population Level ◽

Chronically Ill ◽

Household Composition ◽

Health Related Research ◽

Health Related ◽

The Uk ◽

The Impact

The effect of the wider social-environment on physical and emotional health has long been an area of study. Extrapolating the impact of the individual's immediate environment, such as living with a smoker or caring for a chronically-ill child, would potentially reduce confounding effects in health-related research. Surveys, including the UK Census, are beginning to collect data on household composition. However, these surveys are expensive, time consuming, and, as such, are only completed by a subsection of the population. Large-scale, linked databanks, such as the SAIL Databank at Swansea University, which hold routinely collected secondary use clinical and administrative datasets, are broader in scope, both in terms of the nature of the data held, and the population. The SAIL databank includes demographic data and a geographic indicator that makes it possible to identify groups of people that share accommodation, and in some cases the familial relationships among them. This paper describes a method for creating households, including considerations for how that information can be securely shared for research purposes. This approach has broad implications in Wales and beyond, opening up possibilities for more detailed population-level research that includes consideration of residential social interactions.

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